In resource-limited settings where tuberculosis is a major cause of mortality among HIV patients and where a multidrug-resistant TB epidemic is emerging, researchers are pressing for approaches to integrate TB prevention and treatment into HIV care and treatment.
"HIV programs have no option but to address TB vigorously to save patient lives, safeguard the massive investment in HIV treatment, and to curb the global TB burden," said Diane V. Havlir, MD, chief of UCSF's HIV/AIDS Division at San Francisco General Hospital's Positive Health Program and lead author of a special communication.
The authors propose several strategic approaches to reduce TB burden for HIV care and treatment programs. They include:
One highly recommended measure is intensified TB case finding. The most effective TB control measure is finding and promptly treating TB, according to the authors. Patients with HIV who are undergoing care should be screened for TB along with members of their household, and the HIV patients who have active TB should be treated for this disease within the HIV program. The authors note that because TB may be the disease that brings an HIV patient into care and there are many more clinics for TB than HIV, HIV patients with active TB often are treated in TB clinics and later referred to an HIV program.
The authors emphasize that TB infection control measures should be implemented in both outpatient and inpatient HIV care facilities so that TB is not transmitted in these settings. TB should be recorded and reported to national TB programs by HIV programs to ensure effective tracking of the TB epidemic, and there should be joint HIV and TB planning, they add.
The National Institute of Allergy and Infectious Diseases provided funding for the study.
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